Provider Demographics
NPI:1205979234
Name:INTERVENTION NETWORK INC.
Entity type:Organization
Organization Name:INTERVENTION NETWORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:DERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-422-2606
Mailing Address - Street 1:PO BOX 871004
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-6004
Mailing Address - Country:US
Mailing Address - Phone:734-422-2606
Mailing Address - Fax:724-422-2608
Practice Address - Street 1:8410 FLAMINGO ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1762
Practice Address - Country:US
Practice Address - Phone:734-422-2606
Practice Address - Fax:734-422-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M95490Medicare ID - Type UnspecifiedGROUP PRACTICE